Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction

The optimal means of assessing articular displacement during closed reduction of distal radius fractures is unknown. The purpose of this study was to evaluate the in vivo accuracy of fluoroscopy (C-arm) and plain radiographs (XR) in measuring articular step-off and gap and to determine if postreduction arthroscopy can identify malreduced intra-articular fractures that would benefit from reduction. Fifteen intra-articular distal radius fractures underwent closed manipulation and percutaneous pinning. Reduction was assessed sequentially by C-arm, XR, and wrist arthroscopy. The width of gapping between articular surface fragments was underestimated to a statistically significant degree by both C-arm and XR. The magnitude of articular step-off measured with arthroscopy was not statistically different than that measured radiographically. In 5 (33%) cases, the optimal reduction obtained using C-arm and XR was found to have an articular displacement of >1mm by adjunctive arthroscopy. Complete reduction and pinning was performed with satisfactory results. These results suggest that adjunctive arthroscopy may detect residual gapping of the articular surface that is not seen by C-arm or XR. Residual displacement noted by adjunctive arthroscopy may prompt another reduction effort and result in an improved articular alignment of intra-articular distal radius fractures.